II. Indications
- Rheumatoid Arthritis Third-line DMARD agent
- Rheumatoid Nodulosis
- Wilson's Disease
III. Contraindications
IV. Efficacy
- Response in 70% of Rheumatoid Arthritis
- Slow response requires 4-6 months
V. Adverse Effects
- Adverse effects are common and require stopping drug
- Nausea
- Gastrointestinal upset
- Rash
- Stomatitis
- Dysgeusia
- Cytopenia (5%)
- Proteinuria in membranous nephritis (5-20%)
VI. Dosing: Rheumatoid Arthritis
- Start low and increase very slowly
- Month 1: 250 mg per day
- Month 2: 500 mg per day
- Month 3: 750 mg per day
- Month 4: 1000 mg per day
- Maintenance Dose: 750 to 1000 mg per day
- Lowest Effective Dose: 500 mg per day
VII. Dosing: Wilson's Disease
- Penicillamine 1 g PO before meals and at bedtime
- Keep Serum free copper <2 umol/L (<10 ug/dl)
- Continue life-long in Wilson's Disease
VIII. Monitoring (2-3 times weekly on starting Penicillamine)
IX. Precautions
- Observe for Hypersensitivity Reaction
- Treat Hypersensitivity with Prednisone if occurs